Introduction
What is diagnosis of gout to begin with? Gout is the pain resulting from your body immune system attacking uric acid crystals that are depositing in joints. Few conditions must be met for a person to get gout:
- 1.high uric acid level
- 2.uric acid deposit in your joints in form of crystals
- 3.the immune system attacks the joints.
Not all people with high uric acid will get gout or men would be in tight situation specially all muscular men.
Do you have gout? Keep in mind that there is 2 ways a disease shows itself:
- 1.classical way which is way more common
- 2.a way that is elusive that takes doctors some time to figure out.
Classical gout diagnosis
I will be focusing on the first not second. Typically, most patients I have seen who present with elusive ways has had gout in classical way for years but either ignored by patient or not treated properly. Gout crystals seem to like going to the feet and lower extremities more but can go to joint in your upper extremities as disease becomes more chronic.
Gout attack causes sudden swelling of a joint with extreme pain. Usually, it takes 1-2 days, and the joint is so painful that the person cannot lay a sheet on it. To paint a mental picture, I have seen war veterans cry from gout pain. Usually, gout is depicted as a demon biting the toes. Long story short, I want to say that not every person with high uric acid and joint pain has automatic diagnosis of gout.
Common reasons for gout referral
There is a long list of reasons for joint pains and there are millions of people with high uric acid with no gout. Typically, as Rheumatologist we like to take a sample of the fluid from the joint to diagnose gout. Practically, the patient comes to me in clinic after all is done and attack stopped. Therefore, the most common ways gouts get diagnosed are:
- .1.Podagra which is the classical large toe angry swelling that could make veterans cry
- 2.Tophi which are chalky like material under the skin over the joints. At times behind the ears
Demographics and underlying disease as risk of gout diagnosis
There are obviously chronic issues that patients might have that makes me think of gout. Individuals with chronic kidney disease have a higher chance of gout because they cannot get rid of uric acid properly as the kidney is not working that well. Some ethnicities are genetic and possibly due to diet reasons are at higher risk of gout.
Generally, premenopausal females rarely have higher uric acid. However, Filipino decent patients (even females) might carry genes that makes their kidney lose the ability to get rid of uric acid effectively. I believe it is called ABCG2 gene. At times in Rheumatology, ethnicity matters as we notice patterns that are different. A sidetrack, there is a reason why I like to talk to and attend lectures on Rheumatology from docs across the USA and the world.
gout diagnosis side hints or additional symptoms
What supports gout diagnoses sometimes? Uric acid when it deposits in joints causing gout, it might make stones in the kidneys. Not all people with gout get kidney stones and not every kidney stone from high uric acid will lead to gout. Obviously, if a patient has both, the more important is to manage these issues by lowering uric acid level.
Stories on uncommon presentation of gout diagnosis
Briefly on uncommon manifestations through a story. I had a 50ish year-old male sent to me for Rheumatoid arthritis as he had hand swelling. As a Rheumatologist, even if I am suspecting Rheumatoid arthritis which is usually pains that develop over 3 months’ time, I always send uric acid level. This man’s Rheumatoid tests were negative, but the uric acid was super high. I asked him if he had gout attacks and immediately, he said yes but a long time ago. I knew then that his pain is gout related. He was undertreated for decades, so he slowly got used to the pain. That was a sad story that ended well once his uric acid got controlled.
Another story was a 70-year-old man with sudden swelling of the hands and its tendons. Of course, I thought first and foremost of infection. Both bacterial and fungal infections can lead to sudden swelling of the hands, especially in patients above 65 as the immune system slows down a bit. I think of hand infections in jobs that can cause hand injuries such as construction workers and gardeners. However, this patient’s MRI did not show signs or concern for infection. Remember the podagra description of sudden (happened within 1-2 days) intolerable pain that made the strongest warriors cry, it happened to this patient but in his hands not feet.
Final word
The above 2 stories and classical podagra would likely encompass most gout cases. Of course, other presentations are possible but common is common. You can reach out to this article if you have questions on how gout is managed.
2015 Gout Classification Criteria: An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative
Rheumatology (Hoboken, N.j.)
